One program that Marion County administers for four counties (Marion, Lucas, Wayne and Monroe) involves Maternal Health Services. Agan is concerned because 77 percent of Iowa's 99 counties do not administer this program as a County entity. They work through a community action organization.
Dorn indicated that Marion County is a funder of last resort for all programs. She said the program Agan was questioning has always covered all of its expenses.
Agan was concerned about the overhead costs of administering programs. Dorn said these overhead costs would be incurred by the County, regardless of the programs it administers, but if the program was administered outside of Public Health, the programs could be more costly.
Supervisor Jim Kingery suggested that Mid-Iowa Community Action, another agency which has requested space in the former Department of Human Services building in Marion County, could possibly administer some of the social programs operated by Public Health. When the supervisors were asked if asking this organization to perform tasks, already performed by Public Health, would increase overhead, Kingery said he does not believe it would cost more. Agan replied that a hold harmless agreement would be in place to avoid raising costs to Marion County while providing better services to residents in need.
Van Zante added that most counties do not administer state programs because they are too poor to do so. She, too, recognizes that outside funding sources will deplete, and will require change for the future.
"We're going to have to work smarter, as well as harder," Van Zante said. "It's coming, whether we like it or not."
She wants the county to plan ahead. The supervisors and Health Board agree that some questions will need to be answered before they can properly map out a strategy for the future. Raymie suggested a subgroup be formed to try to gather more information, to bring back before the boards, for further discussion.
Public Health also discussed reaching out to better educate the community regarding services available and what Public Health does.